Case Series: Iodopovidone Pleurodesis for Pediatric Spontaneous Pneumothorax
DOI:
https://doi.org/10.70422/b8rmgb96Keywords:
Case Report, Pneumothorax, Pediatric Surgery, Chemical Pleurodesis, Iodine Pleurodesis, Iodopovidone Pleurodesis, Spontaneous Pneumothorax, iodopovidone, povidone iodineAbstract
Background: Treatment of pediatric primary spontaneous pneumothorax (PSP) with tube thoracostomy alone has been associated with a 66% recurrence rate at our institution. We sought to decrease recurrence with a simple and cost-effective intervention: iodopovidone chemical pleurodesis. An institutional protocol was developed and implemented, addressing indications, informed consent, iodopovidone (povidone iodine) concentration, mixture with lidocaine, method of administration, dwell time, pain control, and safety measures. Iodopovidone pleurodesis was offered to children who would have otherwise been treated with tube thoracostomy alone on our existing PSP protocol.
Case Presentation: Three patients aged 15-17 years, including one with shellfish allergy, were admitted for treatment of PSP. After informed consent was obtained, all patients underwent iodopovidone chemical pleurodesis under our institutional protocol. In all cases, pain control was excellent with 0-3 doses of post-procedure opioid administered. Air leak was absent on post-procedure day 1 in all patients. All patients were discharged on post-procedure day 3 or 4 in excellent condition, and remain free of pneumothorax recurrence at 4-9 months.
Discussion: Pediatric PSP has a high rate of recurrence both locally and in the published literature. Ideal treatment would accomplish a rapid and durable resolution of PSP, with minimal healthcare utilization and costs, and minimal recurrence risk. Iodopovidone is cost-effective, readily available, easy to handle, antibacterial, safe, and effective for pleurodesis. Our initial experience demonstrates this approach is feasible in the pediatric population.
Conclusion: Iodopovidone pleurodesis is a simple, cost-effective, and well-tolerated treatment for PSP. In patients receiving tube thoracostomy for PSP, iodopovidone pleurodesis may reduce recurrence and need for operative intervention.
References
1. Dotson, K., Timm, N., & Gittelman, M. (2012). Is spontaneous pneumothorax really a pediatric problem? A national perspective. Pediatric emergency care, 28(4), 340-344. doi:10.1097/pec.0b013e31824d9a65 DOI: https://doi.org/10.1097/pec.0b013e31824d9a65
2. Williams, K., Lautz, T. B., Leon, A. H., & Oyetunji, T. A. (2018). Optimal timing of video-assisted thoracoscopic surgery for primary spontaneous pneumothorax in children. Journal of pediatric surgery, 53(9), 1858-1861. doi:10.1016/j.jpedsurg.2017.11.047 DOI: https://doi.org/10.1016/j.jpedsurg.2017.11.047
3. Williams, K., Oyetunji, T. A., Hsuing, G., Hendrickson, R. J., & Lautz, T. B. (2018). Spontaneous pneumothorax in children: national management strategies and outcomes. Journal of Laparoendoscopic & Advanced Surgical Techniques, 28(2), 218-222. doi:10.1089/lap.2017.0467 DOI: https://doi.org/10.1089/lap.2017.0467
4. Tragesser, C. J., Hafezi, N., Colgate, C. L., Gray, B. W., & Landman, M. P. (2022). Early surgery for spontaneous pneumothorax associated with reduced recurrence, resource utilization. Journal of Surgical Research, 269, 44-50. doi:10.1016/j.jss.2021.07.007 DOI: https://doi.org/10.1016/j.jss.2021.07.007
5. Spezzotto, G., Boscarelli, A., Giangreco, M., et al. (2022). Management of primary spontaneous pneumothorax in a third-level pediatric surgical center: a retrospective study. Frontiers in Pediatrics, 10, 945641. doi:10.3389/fped.2022.945641 DOI: https://doi.org/10.3389/fped.2022.945641
6. Brown, S. G., Ball, E. L., Perrin, K., et al. (2020). Conservative versus interventional treatment for spontaneous pneumothorax. New England Journal of Medicine, 382(5), 405-415. doi:10.1056/nejmoa1910775 DOI: https://doi.org/10.1056/nejmoa1910775
7. Speck, K. E., Kulaylat, A. N., Baerg, et al. (2023). Evaluation and management of primary spontaneous pneumothorax in adolescents and young adults: a systematic review from the APSA Outcomes & Evidence-Based Practice Committee. Journal of pediatric surgery, 58(10), 1873-1885. doi:10.1016/j.jpedsurg.2023.03.018 DOI: https://doi.org/10.1016/j.jpedsurg.2023.03.018
8. Walker, S. P., Bibby, A. C., Halford, P., Stadon, L., White, P., & Maskell, N. A. (2018). Recurrence rates in primary spontaneous pneumothorax: a systematic review and meta-analysis. European Respiratory Journal, 52(3). doi:10.1183/13993003.00864-2018 DOI: https://doi.org/10.1183/13993003.00864-2018
9. Lopez, M. E., Fallon, S. C., Lee, T. C., Rodriguez, J. R., Brandt, M. L., & Mazziotti, M. V. (2014). Management of the pediatric spontaneous pneumothorax: is primary surgery the treatment of choice?. The American Journal of Surgery, 208(4), 571-576. doi:10.1016/j.amjsurg.2014.06.009 DOI: https://doi.org/10.1016/j.amjsurg.2014.06.009
10. Stewart, S., Fraser, J. A., Rentea, R. M., Aguayo, P., Juang, D., Fraser, J. D., ... & Peter, S. D. S. (2023). Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis. Journal of pediatric surgery, 58(8), 1446-1449. doi:10.1016/j.jpedsurg.2022.12.034 DOI: https://doi.org/10.1016/j.jpedsurg.2022.12.034
11. Mishra, D. R., Bhatta, N., Koirala, P., Shah, B., Bista, B., & Shah, N. (2021). Success of Using Iodopovidone as a Sclerosing Agent for Chemical Pleurodesis in a Tertiary Care Center: A Descriptive Cross-Sectional Study. JNMA: Journal of the Nepal Medical Association, 59(233), 69. doi:10.31729/jnma.6033 DOI: https://doi.org/10.31729/jnma.6033
12. Mahmodlou, R., Rahimi-Rad, M. H., & Alizadeh, H. (2011). Efficacy and safety of iodopovidone pleurodesis through chest tube in spontaneous pneumothorax. Pneumologia (Bucharest, Romania), 60(2), 78-80. https://pubmed.ncbi.nlm.nih.gov/21823357/
13. Agarwal, R., Khan, A., Aggarwal, A. N., & Gupta, D. (2012). Efficacy & safety of iodopovidone pleurodesis: a systematic review & meta-analysis. Indian Journal of Medical Research, 135(3), 297-304. https://pmc.ncbi.nlm.nih.gov/articles/PMC3361864/
14. JJ, F. A., & Unzueta, M. C. (2003). Spontaneous pneumothorax: pleurodesis with an iodo-povidone hydroalcoholic solution. Archivos de Bronconeumologia, 39(4), 171-174. doi:10.1016/s0300-2896(03)75352-6 DOI: https://doi.org/10.1016/s0300-2896(03)75352-6
15. Long, W. G., Cai, B., Liu, Y., & Wang, W. J. (2020). Povidone-iodine chemical pleurodesis in treating spontaneous chylothorax in pediatric patients. Annals of Palliative Medicine, 9(3), 1004012-1001012. doi:10.21037/apm-20-926 DOI: https://doi.org/10.21037/apm-20-926
16. Huang, S. W. (2005). Seafood and iodine: an analysis of a medical myth. In Allergy and asthma proceedings (Vol. 26, No. 6, p. 468). OceanSide Publications; 1999. https://www.ingentaconnect.com/content/ocean/aap/2005/00000026/00000006/art00010
Downloads
Published
Issue
Section
License
Copyright (c) 2025 The Pacific Northwest Journal of Surgery
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
